Wiki Thrombectomy AV Graft

[bailsb]

Is this just 36870 or is there more to this than what I am seeing? I also posted this in cardio thoracics, but might get more of a response on GS blog. Any helpers?

After IV sedation was given, we prepped and draped the left upper extremity. After that we thoroughly infiltrated with 1% lidocaine local to level to the above incision. We identified the graft easily. This was controlled with a vessel. We then heparinized the patient and then proceeded treating the graftotomy in a transverse fashion. Using a 5-mm embolectomy to remove thrombus and found excellent backbleeding of the venous out flow. Several areas were ballooned and opened. We then turned out attention towards brachial artery anastomosis and this was easily crossed using an embolectomy catheter. We retrieved fair amount of thrombus until excellent inflow was obtained. The thrombus was removed. We repaired the graftotomy with a 6-0 prolene 2- layer closure for hemostasis. There was a thrill and audible bruit within the graft after completion. After satisfactory hemostatis, we irrigated with saline, proceeded to close the deep fascia with 3-0 vicryl, followed by subcuticular 4-0 vicryl suture. Dry, sterile dressing were applied. All counts were correct at the end of the case.

Thank you,
Brendan Bailey, CPC

 

[jewlz0879]

I would consider 36831 because 36870 is percutaneous and I interpret this that it was an open incision into the graft. 36831 is for open thrombectomy of AV graft without graft revision.

The AV graft is considered one vessel for coding purposes so even though the physician performed open thrombectomy in both venous and arterial vessels youcode only 36831.

I don't believe I would code any PTA's since the dictation is not specific as to where those balloons were performed and if S&I was completed. I think stating, "sevel areas were ballooned and opened" won't be enough to support 35476/75978. You can certainly query the physician.

HTH

 

[bailsb]

Hi Julie,

That's exactly why I posted this. The documentation is a bit vague, but I agree this was an open incision - 36831. I had 36476/75978 on my notes with questions marks, but your response has answered those questions. I'll consider querying. I really appreciate your response.

Thank you,
Brendan